Re-imagining poppers regulation in Canada

Perspectives from pharmacists, pharmacy students and public health practitioners

Bibliographic Data

ID21594782
AuthorsTimothy Lim (0000-0003-4044-2236, University of Toronto, corresponding author), Kristy Scarfone (0009-0009-3645-2862, University of Toronto), Jordan Ramnarine (0000-0002-3737-3228, Toronto Metropolitan University), Cameron Schwartz (0000-0003-0316-0440, British Columbia Centre on Substance Use), Alexander Burke (The University of Sydney), Tyiesha Wright (University of Toronto), Alexa Harvey (University of Ottawa), Tristan Lai (0009-0008-1622-5972, University of British Columbia), Emmanuel Thibaudeau, Jaris Swidrovich (0000-0002-3274-7630, University of Toronto)
Year2026
Volume153
Pages105308
Publication date2026-07-01
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueInternational Journal of Drug Policy (JOURNAL)
Journal identifiersISSN: 0955-3959 • E-ISSN: 1873-4758
PublisherElsevier BV (PUBLISHER)
DOI10.1016/j.drugpo.2026.105308
PMID42070397
OpenAlexW7160212684
LanguageEN
References cited28

Alkyl nitrites, commonly known as poppers, remain widely used in Canada despite regulatory prohibitions that restrict their sale as prescription-only substances. This incongruence between policy and practice has contributed to unregulated supply chains, product contamination, and missed opportunities for harm reduction - particularly among gay, bisexual, and other men who have sex with men, who use poppers at higher rates. This commentary examines the implications of reclassifying poppers as Schedule II drugs, permitting pharmacist-mediated, non-prescription access, drawing on perspectives from pharmacists, pharmacy students, and public health practitioners. It comes at a time where retrenchments in provincial harm reduction efforts, like British Columbia's end of its drug decriminalization and similar reversals in harm reduction programs in Ontario, are occurring. We explore four intersecting domains: public health implications, professional responsibilities, harm reduction, and patient rapport. A regulated pharmacy model could improve product quality, strengthen pharmacovigilance, and support real-world monitoring of adverse events; however, longstanding challenges such as under-reporting, inconsistent documentation of Schedule II products, and operational barriers may limit the robustness of these data. Pharmacists' clinical responsibilities would require careful clinical assessment, while balancing ethical principles and patient autonomy. Within a harm-reduction framework, pharmacists could offer tailored counselling on safer use, sexual health strategies, and polysubstance risks. Yet, meaningful implementation requires addressing stigma, gaps in cultural competency, and variability in pharmacists' comfort discussing sexualized drug use. Ultimately, pharmacist-led provision of poppers has the potential to enhance safety, accessibility, and sexual well-being, but must be accompanied by targeted training, supportive infrastructure, and community-informed approaches to ensure equitable and effective practice

Decriminalization · Harm · Harm reduction · Health care · Polysubstance dependence · Public health · Reproductive health · Forensic Toxicology and Drug Analysis · Pharmaceutical Quality and Counterfeiting · Poisoning and overdose treatments · Pharmacy

Tools

Open DOIOpen Access